Uterine Fibroids Treatment

Uterine fibroids also known as leiomyomas are muscle and tissue growths developed on the walls of the uterus. They can form on the wall of the uterus, inside the main cavity or on the outer surface of the uterus. These growths are usually non-cancerous and can range from 1 mm to over 20 cm in size. Small fibroids without symptoms typically don’t require treatment. However, treatment is often needed to manage and treat symptoms from larger fibroids.

There are four major types of uterine fibroids, namely:

Intramural Fibroids

Intramural fibroids are the most common type of uterine fibroids. These develop within the muscular wall of the uterus, just beneath the endometrium lining. In some cases, intramural fibroids can grow to an extent that they can stretch out the uterus.

Submucosal Fibroids

Submucosal fibroids are the least common type and develop in the middle muscle layer, or the myometrium, of the uterus. These fibroids affect the fallopian tubes, which may interfere with the fertilisation process. This makes it difficult for the woman to get pregnant. If these fibroids develop during pregnancy, then there is an increased risk of miscarriage or congenital defects.

Subserosal Fibroids

Subserosal fibroids are quite common and grow on the outer layer or the serosa of the uterus. If they grow large enough, they can make the uterus appear enlarged on one side. Growing outside the uterus, subserosal fibroids generally do not interfere with the reproductive system, but they can put pressure on surrounding organs like the bladder or bowel.

Pedunculated Fibroids

Pedunculated fibroids grow out of the uterine wall; either internally or externally, on a long stalk. They can be quite painful if the stalk twists on itself, cutting off the blood supply to the fibroid.

The exact cause of uterine fibroids is not yet known, but scientists believe that hormones and genetics play a major role. Ovaries produce oestrogen and progesterone, which cause the endometrium lining to regenerate with each menstrual cycle. These hormones also play a major role in stimulating the growth of fibroids.

The following are the risk factors associated with the formation of uterine fibroids:

• Family history
• Age 30 years or older
• Obesity or a high BMI
• Early menstruation or late menopause
• Not having children
• Vitamin D deficiency

Smaller fibroids don’t cause any symptoms. However, with larger fibroids, one may experience the following symptoms:

• Excessive or painful menstrual bleeding
• Irregular periods
• Menstrual clots
• Abdominal bloating
• Frequent urination
• Lower back pain
• Constipation
• Pain during intercourse

Diagnosis of uterine fibroids involves several key steps to confirm the presence of fibroids and determine their size and exact location.

MRI/CT scan

Magnetic resonance imaging and computed tomography scans provide detailed images of the uterus from several angles.

Ultrasonography

Ultrasonography is an imaging technique that uses sound waves to create images of the internal organs; in this case the uterus. It gives a clear picture that confirms the presence or absence of fibroids.

Hysteroscopy

A hysteroscope composed of a small telescope with a camera is inserted into the uterus via the cervix, in a procedure called hysteroscopy. Saline solution is injected to expand the uterine cavity for better viewing. Being closer to the fibroids, a hysteroscope provides better images.

Hysterosalpingography

Hysterosalpingography uses a dye, to highlight the uterine cavity and the fallopian tubes on X-ray images, giving a clearer view of the organ. It is best used for submucosal fibroids.

The type of uterine fibroids' treatment will depend on several factors including age, fibroids size and overall health. A combination of approaches can be taken as well, depending on the case. 

Watchful Waiting 

If symptoms are mild or absent, the doctor may recommend a wait-and-watch approach, along with lifestyle changes healthy eating and regular exercise. Fibroids, that are not cancerous, might shrink or go away on their own.

Medications

Medication helps shrink the fibroids and treat the symptoms. Birth control pills are often used to reduce the bleeding and anti-inflammatory medicines are prescribed to ease pain.

Another type of medication, gonadotropin-releasing hormone (GnRH) agonists, work by shrinking the fibroids. 

Surgery

Surgery is the definitive treatment of fibroid. 

• Myomectomy: Surgical removal of fibroid is called myomectomy. We can do myomectomy by different routes.
• Laparotomy: In this, a large incision is made in the abdomen to remove fibroid.
• Laparoscopic Myomectomy: This is done with the help of a laparoscope.
• Robotic Myomectomy: This is done through robotic assistance with a minimally invasive procedure. 

One of the major complications associated with uterine fibroids is anaemia. Heavy blood loss that causes a drop in red blood cells can lead to anaemia, which can be managed with the help of iron supplements.

Other complications include infertility and abdominal or pelvic swelling.

Uterine fibroids cannot be prevented, but certain lifestyle changes help mitigate the risk. These lifestyle habits include:

• Eating cruciferous vegetables like broccoli, kale, and cauliflower.
• Exercising daily, helps maintain overall fitness and health. 
• Getting regular pelvic exams to detect fibroids at an early stage.

How do uterine fibroids affect fertility or pregnancy outcomes?

Submucosal fibroids can interfere with the fertilisation process, as this type of fibroid can block the fallopian tubes. During pregnancy, depending upon the size and exact location of the fibroid, there are chances of preterm labour and miscarriage.

What is the difference between fibroids and polyps?

Uterine fibroids are really common, benign growths of muscle and fibrous tissue that develop in or on the wals of the uterus. Polyps, however, are abnormal growths that originate from the inner layer of the uterus called the endometrium. 

Polyps are generally smaller and softer and cause irregular bleeding. In contrast, fibroids tend to be larger and can cause a variety of symptoms such as severe bleeding, pelvic pain, or pressure on adjacent organs.

What effect does menopause have on uterine fibroids?

Menopause causes a decrease in hormone levels, which can cause uterine fibroids to shrink. Symptoms that occur with fibroids, like heavy bleeding or pelvic pain, often become better or even disappear after menopause; however, fibroid growth may occur in women who receive hormone replacement therapy after menopause.

Can alternative or natural treatments help with uterine fibroids?

Although there is limited scientific evidence supporting alternative or natural remedies to shrink the size of fibroids, many women reportedly feel well with lifestyle changes, including a healthy weight, diet rich in fruits and vegetables, taking herbal supplements, practising acupuncture, andengaging in yoga, and other stress management techniques. It is best to consult a doctor to ensure these align well with medical treatment, before implementing them.

Can uterine fibroids eventually lead to uterine cancer?

Almost all uterine fibroids are benign and do not increase the risk for uterine cancer. It is highly unlikely that a fibroid will be cancerous. In sporadic cases, leiomyosarcomas-a type of cancerous fibroids-can occur; however, this is distinct from benign fibroids, and it is not believed that cancerous fibroids arise from existing benign fibroids.

Reviewed By Dr. Parinita Kalita, Associate Directo - Obstetrics And Gynaecology, Robotic Surgery, Gynaecologic Laparoscopy on 13 Dec 2024.

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